scholarly journals Identification of acute respiratory distress syndrome subphenotypes de novo using routine clinical data: a retrospective analysis of ARDS clinical trials

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e053297
Author(s):  
Abhijit Duggal ◽  
Rachel Kast ◽  
Emily Van Ark ◽  
Lucas Bulgarelli ◽  
Matthew T Siuba ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Data ◽  
Distress Syndrome ◽  
Secondary Outcome ◽  
Data Set ◽  
Study Objective ◽  
Clinical Variables

ObjectivesThe acute respiratory distress syndrome (ARDS) is a heterogeneous condition, and identification of subphenotypes may help in better risk stratification. Our study objective is to identify ARDS subphenotypes using new simpler methodology and readily available clinical variables.SettingThis is a retrospective Cohort Study of ARDS trials. Data from the US ARDSNet trials and from the international ART trial.Participants3763 patients from ARDSNet data sets and 1010 patients from the ART data set.Primary and secondary outcome measuresThe primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared with biomarker data, allowing identification of subphenotypes.ResultsData from 4773 patients were analysed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO2, arterial pH and FiO2. Participants in subphenotype B showed increased levels of proinflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28 and longer duration of ventilation compared with patients in the subphenotype A.ConclusionsRoutinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials.

scholarly journals Identification of Acute Respiratory Distress Syndrome subphenotypes denovo using routine clinical data: a retrospective analysis of ARDS clinical trials

2021 ◽  
Author(s):  
Abhijit Duggal ◽  
Rachel kast ◽  
Emily Van Ark ◽  
Lucas Bulgarelli ◽  
Matthew Siuba ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Data ◽  
Distress Syndrome ◽  
Secondary Outcome ◽  
Clinical Variables ◽  
Optimal Separation ◽  
Precision Therapy

Rationale: The acute respiratory distress syndrome (ARDS) is a heterogenous condition, and identification of subphenotypes may help in better risk stratification. Objectives: Identify ARDS subphenotypes using new simpler methodology and readily available clinical variables. Design: Retrospective Cohort Study of ARDS trials. Setting: Data from the U.S. ARDSNet trials and from the international ART trial. Participants: 3763 patients from ARDSNet datasets and 1010 patients from the ART dataset. Primary and secondary outcome measures: The primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. For feature selection, sets. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared to biomarker data, allowing identification of subphenotypes. Results: Data from 4,773 patients was analyzed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely: heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO2, arterial pH, and FiO2. Participants in subphenotype B showed increased levels of pro-inflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28, and longer duration of ventilation compared to patients in the subphenotype A. Conclusions: Routinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials.

What is Acute Respiratory Distress Syndrome?

1998 ◽  
Vol 13 (2) ◽  
pp. 59-67 ◽  
Author(s):  
Marc Moss ◽  
Polly E. Parsons
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clear Definition ◽  
History Of ◽  
Definition Of ◽  
Major Illness

Acute respiratory distress syndrome (ARDS) is a form of acute lung injury which usually occurs within 24 hours of a major illness or injury. Unfortunately a clear definition of ARDS does not presently exist, and the variability in the diagnostic criteria may impact on the results of clinical trials for ARDS and our understanding of the epidemiology and pathogenesis of this syndrome. In this article the history of ARDS is reviewed and a few of the definitions that have evolved over wtime are explored in depth. In addition, several controversies with these existing defiitions are discussed.

scholarly journals Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

2015 ◽  
Vol 43 (5) ◽  
pp. 1026-1035 ◽  
Author(s):  
Jeremy R. Beitler ◽  
B. Taylor Thompson ◽  
Michael A. Matthay ◽  
Daniel Talmor ◽  
Kathleen D. Liu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Dead Space ◽  
Distress Syndrome ◽  
Secondary Analyses

scholarly journals Recent advances in the understanding and management of ARDS

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1959 ◽  
Author(s):  
Tyler J Peck ◽  
Kathryn A Hibbert
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Critical Illness ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Standard Of Care ◽  
Therapeutic Interventions ◽  
Morbid Condition ◽  
Ventilation Strategies

The acute respiratory distress syndrome (ARDS) remains a common and highly morbid condition despite advances in the understanding and management of this complex critical illness. Recent work has illuminated the heterogeneity within ARDS and demonstrated the likely impact of heterogeneity on the identification of effective therapeutic interventions. Despite these challenges, new data have also informed the standard of care for ARDS and have resulted in the re-evaluation of previously established therapies, including ventilation strategies, pharmacologic interventions, and rescue therapies. As the field of ARDS continues to evolve, innovative approaches will be needed to further define phenotypes within ARDS and design targeted clinical trials.

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